OBJECTIVES When you have completed this unit you should be able to: Manage normal newborn infants. Diagnose and treat common minor problems. Manage breast feeding. Promote baby friendly care. Discharge a normal infant.

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COPYRIGHT All rights reserved. No part of this Perinatal Education Programme may be altered in any way, nor may copies of the complete Programme be made, without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care in Southern Africa, however, parts of the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme are believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

CARING FOR NORMAL INFANTS

37-1 WHAT IS A NORMAL INFANT?

A normal infant has the following characteristics:

1. The infant is born at term (37 to 42 weeks gestation).
2. The 1 minute Apgar score is 7 or more and no resuscitation is needed after birth.
3. The infant weighs between 2500 g and 4000 g at birth.
4. On physical examination the infant appears healthy with no congenital abnormalities or abnormal clinical signs.
5. The infant feeds well.
6. There have been no problems with the infant since delivery.

Normal infants are at low risk of developing problems in the newborn period and, therefore, require primary care only. About 80% of all newborn infants are normal.

NORMAL NEWBORN INFANTS ARE AT LOW RISK OF DEVELOPING PROBLEMS AND REQUIRE ONLY PRIMARY CARE

37-2 SHOULD ALL NORMAL INFANTS BE KEPT WITH THEIR MOTHERS?

Yes, all normal infants should stay with their mothers and not get cared for in the nursery. This is called rooming-in. The infant is either nursed in a cot next to the mother's bed or is given skin-to-skin care (Kangaroo Mother Care or KMC). The advantages of infants staying with their mothers are:

1. The mother remains close to her infant all the times and gets used to caring for her infant. This strengthens bonding..
2. It encourages breast feeding..
3. It builds up the mother's confidence in her ability to handle her infant..
4. It prevents the infant being exposed to the infections commonly present in a nursery..
5. It reduces the number of staff needed to care for infants.

The father should be present at the delivery to share this exciting moment.

MOTHERS AND INFANTS SHOULD STAY TOGETHER

37-3 WHEN SHOULD THE INFANT RECEIVE THE FIRST BATH?

There is no need to routinely bath all infants after delivery to remove the vernix. Vernix will not harm the infant and disappears spontaneously after a day or two. Vernix protects the skin and kills bacteria. Many infants also get cold if they are bathed soon after delivery. The only indication for an infant to be washed or bathed soon after birth is severe meconium staining or contamination with maternal blood or stool.

It is, however, important that all primiparous mothers learn how to bath their infants before they are sent home. If these infants have to be bathed on the first day of life, it is preferable that this be delayed until they are a few hours old.

37-4 WHAT IS THE APPEARANCE OF A NEWBORN INFANT'S STOOL?

For the first few days the infant will pass meconium, which is dark green and sticky. By day 5 the stools should change from green to yellow, and by the end of the first week the stools should have the appearance of scrambled egg. The stools of breast fed infants may also be soft and yellow-green but should not smell offensive.

Some infants will pass a stool after every feed while others may not pass a stool for a number of days. As long as the stool is not hard, the frequency of stools is not important.

37-5 HOW MANY WET NAPPIES SHOULD AN INFANT HAVE A DAY?

A normal infant should have at least 6 wet nappies a day. If the infant has fewer than 6 wet nappies a day, you should suspect that the infant is not getting enough milk. However, during the first 5 days, infants may have fewer wet nappies as infants normally pass little urine in the first few days. This protects them from dehydration at a time when many mothers produce only small amounts of milk.

37-6 WHAT ROUTINE CORD CARE IS NEEDED?

The umbilical cord stump is soft and wet after delivery and this dead tissue is an ideal site for bacteria to grow. The cord should, therefore, be kept clean. It should also be dried out as soon as possible by 6 hourly applications of surgical spirits (alcohol). It is important to apply enough spirits to run into all the folds around the base of the cord. There is no need to use antibiotic powders. If the cord remains soft after 24 hours, or becomes wet and smells offensively, then the cord should be treated with surgical spirits every 3 hours. Do not cover the cord with a bandage. Usually the cord will come off between 1 and 2 weeks after delivery.

GOOD CORD CARE WITH SURGICAL SPIRITS IS IMPORTANT

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